Wastewater data integration and modelling to accurately predict viral outbreaks in long-term care facilities

Project Summary As thought-leaders now deconstruct the recent global pandemic, there is a conclusive and resounding argument to conduct enhanced surveillance to accurately anticipate future outbreaks due to endemic viral pathogens and, that to minimize the global health impact of future outbreaks, we must target the most vulnerable among us. In our recently funded SBIR Phase I project, our team of affiliate scientists developed and implemented a wastewater-sampling approach to monitor for COVID-19 and demonstrated that we can utilize predictive modelling approaches to anticipate future COVID outbreaks by up to seven days. Importantly, these models are flexible and potentially generalizable: leveraging aspects of epidemic trajectories that span numerous disease classes and types. As part of our SBIR Phase I efforts, we also talked to well over 100 different potential clients, industry thought leaders and influencers. These conversations, combined with our technical research, have led us to recognize that the impact of our predictive technology is highest within the U.S. long-term care facility (LTCF (including skilled nursing facilities (SNFs), assisted living facilities (ALFs) and other congregate living facilities (CLFs)) market - a >$173 billion annual market which is rapidly expanding with an aging U.S. population and rising health care costs, further confounded by a massive labor shortage in LTCFs. Our non-invasive (facility-level sewage outflow) sampling which requires little-to-no facility staff time and can lead to highly accurate predictions of impending outbreaks is poised to have a massive and disruptive impact on best practices for infectious disease risk mitigation in the LTCF market. However, while our Phase I work provided critical proof-of-concept data and a clear potential pathway for commercialization, key critical gaps still exist including: (a) validating predictive ability at the facility level, (b) demonstrating the ability to model diseases beyond just COVID-19 to maximize impact (e.g., RSV, Influenza and norovirus) and (c) demonstrating the ability to make predictions in real-time that impact facility level infectious disease behaviors to reduce outbreak impact and yield tangible ROI for LTCFs. Thus, in this Phase II proposal, we leverage our globally recognized team of wastewater based epidemiology (WBE) and data science experts, in partnership with two of the largest U.S. based LTCF networks (Good Samaritan Society; Western Home Services), and the leading non-profit LTCF advocacy organization in the U.S. (LeadingAge) to conduct the critically necessary next steps in testing and implementation of our Phase I technology, in order to position the Aquora SecureCare technology for full commercialization. In Phase II, we will (Aim 1) demonstrate the ability to anticipate locations with future outbreaks across a wide range of infectious disease targets with significant lead time and (Aim 2) demonstrate how WBE model predictions can be optimized to be useful for LTCFs. This Phase II work will provide the critically needed, validation requested by our emerging LTCF partners that will enable us to engage with these and more partners in full "Phase III" commercialization and (external) investment.